Clinical Appeals Coordinator | Concord Hospital | Part Time

Summary The Clinical Appeals Coordinator is responsible for supporting Concord Hospital with claim appeal activities within the Revenue Integrity department. This involves a timely and accurate review of medical records in response to claim denials received from third party payers, Recovery Audit Contractors (RAC), Medicare Administrative Contractors (MAC), as well as medical necessity denials from other governmental and non-governmental payers and auditors. The Clinical Appeals Coordinator will evaluate opportunities for education and provide feedback to physicians the RCC Committee, and other relevant departments. Additionally, this person will serve as a clinical resource to the entire Revenue Management division. Education Bachelor's degree in Nursing from an accredited Nursing program. Certification, Registration & Licensure Experience Minimum of five years’ experience in utilization review and/or auditing in an acute-care hospital setting. Medicare audit and appeal background strongly desired. Must have solid understanding of Medicare levels of care (inpatient/observation). Experience applying Milliman and/or Interqual guidelines required. Familiarity with medical coding, reimbursement, and insurance practices required. Must possess excellent interpersonal, communication, and motivational skills, including the ability to communicate clearly and concisely, both orally and in writing. Ability to work collaboratively with individuals at all levels throughout the organization required. Strong facilitation and presentation skills required. Must use independent judgment in reviewing records to determine appropriate appeal action. Must be able to compose a persuasive appeal using clinical data, regulatory guidelines, evidence-based standards, and applicable legal statute. Strong organizational and time management skills required. Must be able to independently prioritize work. Strong critical-thinking and problem solving skills required. Must be flexible and comfortable in an environment with frequent changing demands and requirements. Strong computer skills required including MS Word and Excel. Responsibilities Performs audits on all assigned clinical denials. Constructs all necessary appeals with payers for reconsideration of denied charges and/or services. Identifies root cause of denials and provides education to Care Managers, Providers and Charge Departments as appropriate. Acts as a clinical resource to Patient Financial Services and other Concord Hospital departments for payment/charge issues and other clinical inquiries that may or may not be related to audits and appeals. Takes responsibility for individual performance goals. Performs other duties as assigned. Concord Hospital is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race, color, religion, sex, sexual orientation, gender, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Know Your Rights: Workplace Discrimination is Illegal Applicants to and employees of this company are protected under federal law from discrimination on several bases. Follow the link above to find out more. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, you may contact Human Resources at 603-230-7269. Concord Hospital (CH) is a nationally-accredited, progressive regional health system. Over the past two decades, CH has evolved from a community hospital to a $550 million net revenue regional integrated health system with more than 3,574 employees, leaders and clinicians who are talented, mutually supportive, and community centered in helping the organization meet its community mission. CH has sophisticated clinical and management practices. The organization consistently performs among the top ten percent of national organizations and has received many national accolades (e.g., most wired, Press Ganey's summit award). After a four-year effort to strengthen and standardize our quality management processes, Concord Hospital has become the first healthcare system in New Hampshire to be certified as being in compliance with internationally recognized quality management practices ISO 9001:2008 certification, issued by DNV GL. ISO certification means that patients can be confident CH has implemented and strengthened processes for internal auditing, control of documents, control of records, control of non conforming products, and preventative and corrective action. Learn more about working at Concord Hospital Culture and Values Career Development Benefits Life Here